Visual snow and other stories . . .

For the past 15 years, health systems have undergone expensive upheavals in response to trial evidence showing that primary percutaneous intervention (PCI) is superior to thrombolysis for acute ST elevation myocardial infarction. If you have your heart attack outside a teaching hospital on a Thursday morning, this is almost certainly true. But if you have it in a French village on a Sunday evening, you might be better off with thrombolysis. In fact, a five year follow-up study of 1492 patients in the French FAST-MI registry (Circulation 2014, doi:10.1161/CIRCULATIONAHA.113.005874) shows generally better survival rates after thrombolysis compared with PCI. This difference largely disappeared with propensity scoring, but the investigators conclude that in a real world setting, on a nationwide scale, a pharmacoinvasive strategy constitutes a valid alternative to PCI, with five year survival at least equivalent to the reference reperfusion method.

Most people who are diagnosed with major depressive disorder (MDD) are first treated with a serotonin reuptake inhibitor (SRI), but this often doesn’t …